LEICESTER INFIRMARY

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an hour and a half after the injection. He then becamevery restless, spasms came on more frequently, and atlast he began to beg for the morphia. His elder brother,who was with him, and the nurse, had great difficulty inkeeping him in bed. His pupils are widely dilated; andhe expectorates saliva freely. The hypodermic injectionwas repeated. 9.30 A.M.: Temperature 1028° ; pulse 120.Slept only ten minutes after last injection, and lay quiet foran hour afterwards. Since then has been very restless, con-tinually getting in and out of bed. The spasms were dis-tressing, and came on each time he moved. There is aquantity of frothy saliva in a vessel near the bed, and alsoabout the floor. He frequently spits as though afraid toretain it in his mouth. He has not taken anything all night.A. little beef jelly was offered to him, but the sight of itmade him jump out of bed and rush across the room

in great terror. He readily held out his arm to re-

ceive the injection of morphia, which was repeated.12 P.M.: The morphia had not the slightest effect; the

pupils are widely dilated. Is getting quite exhausted;hands and feet are cold, as he continually kicks off the bed-.clothes. Any attempt to pull them over him brings onviolent spasm, and he begs not to be touched ; with greatcaution he pulls them over himself. With some difficulty’by holding him down an enema of strong beef-tea wasadministered, but not much was retained. Another hypo-dermic injection of one-third of a grain of morphia wasgiven. 2.15 P.M. : Found right side of face, neck, and chestemphysematous ; right eye being closed by swelling of lids.Evidently some air tube had given way on that side in oneof the spasms, and the air escaped into the cellular tissue.Is gradually sinking from exhaustion; pulse very feeble.Gave a hypodermic injection of brandy, and repeated theinjection of morphia. 5 P.M. : Lies back supported withpillows; is quite exhausted; pulse cannot be felt. Spasmscontinue. Frothy saliva comes away from the mouth.Pupils are widely dilated. Is quite conscious. The patientgradually sank and died at 6.20 P.M.Be7nar7zs.-The only treatment adopted in this case was

the hypodermic injection of hydrochlorate of morphia (one-third of a grain) frequently. It was evident that at first itrelieved the spasms for a time and gave him sleep, and thatwas shown by his craving for it. The pupils were onlyslightly contracted after the first injection, but subsequentlythey dilated, and continued so to the last. The patientspoke quite rationally, and was conscious within a

’few minutes before his death. In conclusion, I may mentionthat the dog was not shot until he had killed a number ofgeese and bitten another dog, which afterwards showedsymptoms of rabies, and had to be destroyed.

LEICESTER INFIRMARY.SERPIGINOUS ULCERATION OF BOTH CORNEÆ; DOUBLE

IRIDECTOMY; RECOVERY, WITH EXCELLENT VISIONIN BOTH EYES.

(Under the care of Mr. FRANK H. HODGES.)A. W- ---, aged fifty, a weaver, was admitted into the Eye

Ward on the 2nd of January, 1884. He had an ulcer of ahorse-shoe shape, affecting rather more than the upper halfof each cornea. Hot belladonna compresses and full dosesof bromide of potassium were prescribed.

Jan. 5th.-The eyes were extremely painful; the ulcera-tion of both corneæ was extending. Eserine and poppyfomentations were ordered.6th.-Pain intense; no sleep last night, notwithstand-

ing a full dose of liquor opii sedativus was given. Underchloroform an upward iridectomy was performed on botheyes.8th.-Right eye ulcer healing; left ulcer is still deep and

unhealthy looking. The eyes are easy since the operation.15th.—Both ulcers slowly healing.Feb. 12th.—Ulcers healed; to be an out-patient.May 19th (four months after operation).-Vision: Right

eye, 6/36 ; left eye, 6/12 and with appropriate glasses (+ 1’5 D.)-fine type (0’5 Snellen) is read.

July 6th, 1885.-The patient has followed his occupation,that of a weaver, over twelve months, and often reads the newspaper without glasses. The corneas are, to an ordinary examination, quite transparent, but on oblique illuminationa semilunar haze in the upper quadrant marks the site ofthe corneal ulceration. ’

On July 9th, at the annual meeting of the Midland Branch

of the British Medical Association, the case was examinedby several members.Remarks by Mr. HoDrES.-The reason why I selected

iridectomy in preference to Saemesch’s corneal section wasthat the ulceration, though extensive, was for the most partsuperficial. To have commenced and finished the incisionin a healthy cornea would have caused a long scar, andinevitably spoiled the eyes for optical purposes. This caseoccurred when I did not know the value of iodoform, which1 have since used with brilliant results in corneal ulcera-tions, especially those of traumatic origin.

Reviews and Notices of Books.A System of Practical Medicine. By American Authors.

Edited by WILLIAM PEPPER, M.D., LL.D., assisted byLouis STARR, M.D. Vol. I. Pathology and General Dis-eases. Vol. IL General Diseases (continued), and Diseasesof the Digestive System. Philadelphia: Lea Brothersand Co. London: Sampson Low, Son, and Marston. 1885.

[FIRST NOTICE.]IT is twenty years since the publication of the first volume

of Reynolds’ System of Medicine proved how needful itwas that if we were to possess a comprehensive account ofdisease, the work should be shared by many writers; forthe domain of medicine had extended beyond the scope ofthe most industrious individual workers. Another ten yearsand the great Cyclopædia edited by Ziemssen carried us tothe extreme limit of works of this class, and represented theoutcome of the thought and scholarship of Germany. Tothe enterprise of the physicians of the United States we owea translation of that great work, and now we have to welcomethe appearance of the first volumes of a work which will

fairly bear comparison with either of its predecessors.In no country has medical learning advanced with suchrapid strides as in America. It possesses some of thebest periodical literature of the day, and has producedsome of the most classical treatises, for it numbers

amongst its professors men who have spared neithertime nor labour in the acquisition of knowledge. It was

time, then, that America produced a system which shouldcombine the fruits of so much learning and experience, andwe have presented to us, without any preliminary flourish,the first instalments of such a work. It is intended to coverthe whole domain of medicine, and the special departmentswill be fully represented. The list of authors includes thenames of physicians whose reputation is world-wide, and ifthe promise which these first volumes bring is maintained tothe end, the result will be a very solid and useful additionto our literature. In its general method and plan the workforcibly reminds us of the English System of Medicine; butit must be confessed that in the number of subjects dealtwith and in the relative extent of the articles the presentwork is superior, although there are contained in the formercertain unrivalled monographs. This comparison, however,is hardly a just one, for the subjects have grown much sincethey were dealt with by the contributors to the Englishvolume, and Dr. Pepper and his coadjutors are in a morefavourable position for presenting a complete " System."We trust that nothing will occur to delay the appearance atregular intervals of the subsequent volumes, and indeed thepromptitude with which the second volume has followedthe first is a good omen for a steady and uniform rate ofpublication.The first volume opens with four articles upon general

pathology and sanitary science. Dr. Reginald H. Fitz con-tributes the article upon General Morbid Processes, whichsurveys in a fairly comprehensive manner the presentstandpoint respecting these processes, and is most interest-ing in the sections devoted to Tuberculosis and MorbidGrowths. This is followed by an article upon General